Pro
1:5 KJV A
wise man will hear, and will increase learning; and a man of understanding
shall attain unto wise counsels:
Beating
Ebola Hinges on Sipping a Gallon of Liquid a Day
- Bloomberg http://bloom.bg/1t3jxuo By
Jason Gale Nov 17, 2014 2:03 AM ET
[Photo caption] Dr. Fadipe Akinniyi Emmanuel,
Ebola survivor, shows the daily dose of oral rehydration... Read More
The best medical advice for surviving Ebola
right now might fit in one word: drink.
With targeted drugs and vaccines at least
months away, doctors and public health experts are learning from Ebola survivors
what simple steps helped them beat the infection. Turns out drinking 4
liters (1 gallon) or more of rehydration solution a day -- a challenge for
anyone and especially those wracked by relentless bouts of vomiting -- is
crucial.
Related Slideshow: Liberia: Ebola's Ground Zero
“When people are infected, they
get dry as a crisp really quickly,” said Simon Mardel,
an emergency room doctor advising the World Health Organization on Ebola in
Sierra Leone. “Then the tragedy is that they don’t want to drink.”
The
Ebola Scourge Aggressive fluid replacement was deemed
critical in saving two American health-care workers with Ebola at the Emory
University Hospital in Atlanta, according to a study published in the New
England Journal of Medicine last week. Interviews Mardel and WHO colleagues
conducted with six of the dozen patients who survived Ebola in Nigeria, where
the fatality ratio was much lower, also point to the importance of drinking.
Ada Igonoh, a doctor who caught Ebola in late July while working at the First
Consultants Hospital in Lagos, said she took oral rehydration salts, or ORS,
mixed in water as soon her gastrointestinal symptoms started -- even before her
Ebola diagnosis. Once hospitalized, she trawled the Internet on her iPad for
insights from survivors.
Photographer: Andrew Esiebo/World Health
Organization via Bloomberg
Ada Igonoh, a doctor who caught Ebola in late
July while working at the First... Read More
Studying in Seclusion
“I knew that in diarrheal
diseases, shock from dehydration is the number one cause of death,”
Igonoh said in an e-mail. “From my research on Ebola while in
isolation, I found that to be true.”
The WHO shared transcripts of interviews with
Igonoh and five other Ebola survivors with the patients’ permission to provide
insight into clinical experiences and management. Igonoh also answered
follow-up questions in a direct e-mail.
Patients in Liberia lost 5 liters of fluid a
day from diarrhea alone, doctors treating cases there wrote in a Nov. 5 paper
in the New England Journal of Medicine.
Severe fluid loss can
cause a type of shock that prevents the heart from pumping enough blood to the
body, eventually leading to multiple organ failure.
“As I took the ORS and treated dehydration, it
provided me with energy, and my immune system was able to battle the virus,”
29-year-old Igonoh said.
Simple
Message Patients become “stunningly dehydrated”
because they don’t feel like eating or drinking in the early stages of the
illness, and then later they lose liters of fluid from profuse sweating,
vomiting and diarrhea, according to Mardel.
“You don’t want to drink, then you’re too
weak,” he said in a telephone interview from Freetown. “In the last stage,
you’re in shock and your gut has shut down.”
Mardel has worked on medical aid and emergency
relief operations for 30 years, including responding to outbreaks of Lassa
fever in Sierra Leone, Ebola in Uganda and Marburg virus disease in the
Democratic Republic of Congo.
Mortality could be reduced by delivering a
simple message about the importance of taking fluids and picking the right
painkillers, he said. Paracetamol, the active ingredient in Panadol, is the
preferred medication for pain and fever, and picking others such as aspirin and
ibuprofen can worsen bleeding, he said.
“We will halve the mortality by
firstly just stopping anti-inflammatories and giving hydration, and really
pushing it,” Mardel said. “I want every man and woman in
Sierra Leone to know this. I want sports personalities to be talking about it.
I want everybody to be talking about it.”
Ebola
Blueprint In Nigeria, 40 percent of those known to have
been infected died. Across the rest of West Africa, the fatality rate is about
70 percent.
Nigeria’s success in stopping Ebola shows how
the virus can be stamped out and is a blueprint for other developing countries
at risk of the disease, the WHO said after declaring Africa’s most-populous
nation Ebola-free last month.
Liberian-American Patrick Sawyer introduced
Ebola to Nigeria in July when he arrived on a flight to Lagos, a city with an
estimated 21 million people, according to the WHO. In addition to Sawyer, five
health workers and the protocol officer who received him at the airport died of
Ebola, according to Nigeria’s health ministry. Twelve survived.
Learning from their experience and putting
those lessons to use in other West African countries is key, because too many
patients arrive at treatment centers severely parched and difficult to salvage,
Mardel said.
Spurning
Care Patients typically seek medical aid after five
days of illness, according to a study of Ebola cases in Conakry also published
Nov. 5 in the New England Journal of Medicine.
“Over eight to 10 days of illness, you will
need possibly 40 liters of fluid,” Mardel said. “Day after day, if you’re not
getting that, we can’t suddenly give you 20 liters to catch up.”
A fluid deficit and “profound electrolyte
derangement” appears to increase the risk of death, the WHO said in a Nov. 6
statement. In that document, the Geneva-based agency recommended intravenous
rehydration. Not everyone agrees that that delivery route is the best way to
go. Oral rehydration, which is taken up in the gut, seems to help patients
maintain a better balance of electrolytes, according to Mardel.
Don’t
Gulp Most intravenous rehydration fluids also don’t
have much potassium, calcium, or magnesium, doctors at Emory University
Hospital wrote in their journal article last week. They recommend supplementing
oral rehydration with all three, especially in patients with large-volume
diarrhea.
Still, drinking has its challenges. Patients
must overcome recurring nausea, as well as debilitating joint pain that can
make gripping and movement difficult.
Ebola survivor Fadipe Akinniyi Emmanuel,
another doctor at the First Consultants Hospital where Igonoh works, said
gulping down the rehydration solution made him sick.
“Each time I attempted to take the ORS, I
vomited,” he told the WHO, according to the transcript. Eventually, Emmanuel
found he could keep down 4 liters of fluids a day by taking frequent, small
sips between bouts of nausea.
‘Most
Important Thing’ Rehydration is “the single most important
thing” in the management of Ebola, Emmanuel said in an e-mailed response to
questions.
“It really helped restore what I was losing
when I was stooling and vomiting relentlessly,” said the 29-year-old doctor,
who still suffers occasional joint pain and stiffness as a result of his past
Ebola infection.
Flavoring the liquid also helps. The granules
that Emmanuel’s colleague Igonoh took at home were orange-flavored and much
more pleasant than the flavorless kind she was given in the hospital, she said.
“I had to mentally force myself,” she said,
according to the transcript.
Igonoh used less of the rehydration salts per
liter of water than recommended because a more diluted brew was easier to
stomach, helping her to increase her intake, she said.
“You don’t want to drink anything,” Igonoh
said. “You are too weak.” That’s when morale is key, said the doctor, who now
sports a shaved head after the viral illness caused most of her hair to fall
out. “You should be able to tell yourself, no matter how many people die, you
are going to survive. And you will survive.”
To contact the reporter on this story: Jason
Gale in Melbourne at j.gale@bloomberg.net
To contact the editors responsible for this
story: Elyse Tanouye at etanouye@bloomberg.net Marthe Fourcade, Terje Langeland
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